Abstract
ObjectiveTo identify the predictors of intrauterine balloon tamponade (IUBT) failure for persistent postpartum hemorrhage (PPH) after vaginal delivery.DesignRetrospective case-series in five maternity units in a perinatal network.SettingAll women who underwent IUBT for persistent PPH after vaginal delivery from January 2011 to December 2015 in these hospitals.MethodsAll maternity apply the same management policy for PPH. IUBT, using a Bakri balloon, was used as a second line therapy for persistent PPH after failure of bimanual uterine massage and uterotonics to stop bleeding after vaginal delivery. Women who required another second line therapy (embolization or surgical procedures) to stop bleeding after IUBT were defined as cases, and women whom IUBT stopped bleeding were defined as control group. We determined independent predictors for failed IUBT using multiple regression and adjusting for demographics with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI).ResultsDuring the study period, there were 91,880 deliveries in the five hospitals and IUBT was used in 108 women to control bleeding. The success rate was 74.1% (80/108). In 28 women, invasive procedures were required (19 embolization and 9 surgical procedures with 5 peripartum hysterectomies). Women with failed IUBT were more often obese (25.9% vs. 8.1%; p = 0.03), duration of labor was shorter (363.9 min vs. 549.7min; p = 0.04), and major PPH (≥1,500 mL) before IUBT was more frequent (64% vs. 40%; p = 0.04). Obesity was a predictive factor of failed IUBT (aOR 4.40, 95% CI 1.06–18.31). Major PPH before IUBT seemed to be another predictor of failure (aOR 1.001, 95% CI 1.000–1.002), but our result did not reach statistical significativity.ConclusionIntrauterine balloon tamponade is an effective second line therapy for persistent primary PPH after vaginal delivery. Pre-pregnancy obesity is a risk factor of IUBT failure.
Highlights
Postpartum hemorrhage (PPH) constitutes a major component of severe maternal morbidity and mortality and complicates approximately 5% to 15% of all deliveries [1]
Obesity was a predictive factor of failed intrauterine balloon tamponade (IUBT)
Major postpartum hemorrhage (PPH) before IUBT seemed to be another predictor of failure, but our result did not reach statistical significativity
Summary
Postpartum hemorrhage (PPH) constitutes a major component of severe maternal morbidity and mortality and complicates approximately 5% to 15% of all deliveries [1]. After failure of primary management of PPH after vaginal delivery, second-line treatments, such as pelvic arterial embolization, vessel ligation, uterine compression sutures, can be attempted to achieve arrest of severe persistent PPH, defined as excessive bleeding (1,000 mL or greater) within the first 24 hours after birth [2], and to avoid peripartum hysterectomy [3,4,5,6]. In a recent large population-based retrospective cohort study included 72,529 women in two French perinatal networks, invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 4.1 per 1,000 deliveries [7]. In a retrospective study in five maternity units in a perinatal network, we aimed to evaluate the effectiveness of IUBT after vaginal delivery for management of persistent PPH, and to identify the risk factors of IUBT failure after vaginal delivery on this population
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